Health Care Reform: The Who, What and When

Reforms Already in Effect

Insurers cannot impose pre-existing condition exclusions for children, remove coverage when a member becomes ill (except in cases of fraud or intentional misrepresentation) or impose lifetime coverage limits.
Non-grandfathered health plans must cover preventive care services without deductibles or other cost-sharing and children can remain on their parent’s health coverage until age 26.
In 2010, Medicare Part D enrollees received a $250 rebate when entering the coverage gap, and in 2011 and 2012, they got a 50 percent discount on brand-name drugs in the coverage gap.
Insurers must spend at least 80 to 85 percent of premiums on medical services each year or pay rebates to consumers.
The federal excise tax on HSA dollars spent on non-medical expenses increased to 20 percent.
OTC drugs (except insulin) are no longer eligible expenses for FSAs, HRAs or HSAs without a prescription.
Medicare payroll taxes rise to 2.35 percent for individuals earning over $200,000 ($250,000 for joint filers).
Additional discounts and subsidies will be phased in for drugs bought in the Medicare Part D coverage gap until the gap is closed in 2020.
The annual limit of $2,500 for individual pretax contributions to an FSA takes effect.
Non-grandfathered health plans must cover additional preventive services for women without cost-sharing.

Insurers cannot refuse to sell or renew policies, deny coverage for pre-existing conditions, set prices based on certain factors or impose annual limits.
Most individuals are required to have health coverage or pay a fine of $95 (up to $295 per family). Penalties will increase in 2015 and 2016.

40 percent tax on high-cost employer-provided policies ($10,200 individual, $27,500 family).